Minimal change nephrotic syndrome after stem cell transplantation: a case report and literature review

Abstract

Graft-versus-host disease is one of the most frequent complications occurring after haematopoietic stem cell transplantation. Recently, renal involvement has been described as a manifestation of chronic graft-versus-host disease. Immunosuppression seems to play a major role: clinical disease is triggered by its tapering and resolution is achieved with the resumption of the immunosuppressive therapy. Prognosis is apparently favourable, but long term follow up data are lacking.We report a case of a 53-year-old man who developed nephrotic syndrome 142 days after allogeneic stem cell transplantation for acute myeloid leukaemia. Onset of nephrotic syndrome occurred after reduction of immunosuppressants and was accompanied by manifestations of chronic graft-versus-host disease. Histological examination of the kidney was consistent with Minimal Change Disease. After treatment with prednisolone and mycophenolate mofetil he had complete remission of proteinuria and improvement of graft-versus-host disease. Eighteen months after transplantation the patient keeps haematological remission and normal renal function, without proteinuria.Since patients with chronic graft-versus-host disease might be considered at risk for development of nephrotic syndrome, careful monitoring of renal parameters, namely proteinuria, is advisable.

Figure 1

Renal biopsy specimen (HE): An essentially normal glomerulus, with open capillary lumens and only minimal hypercellularity.

Figure 2

Renal biopsy specimen (HE): focal loss of tubular epithelial cells and presence of cellular debris inside of the tubules, consistent with acute tubular necrosis; no interstitial fibrosis was present. Immunofluorescence (not shown) was negative.

Figure 3

Renal biopsy specimen (Electron micrograph × 10000): Epithelial cells effaced along the glomerular basement membrane.

Figure 4

Degree of proteinuria before and after PBSCT.